Management of Latent TB infection in Indonesia
Indonesia Country Profile
• • • • • • •
Prevalence : 1,600,000 (647/100,000) Incidence : 1,000,000 (399/100,000) Incidence HIV/TB : 63,000 (25/100,000) Mortality : 100,000 ( 41/100,000) Total cases notified in 2014 : 324,539 Total child TB cases notified in 2014 : 23,176 National HIV prevalence among people aged 15 to 49 yo : 0.41%
High Risk Group and National Recommendations for LTBI Treatment in Indonesia TB High risk group population
Treatment of Latent TB infection in Indonesia focused on : 1. People living with HIV Aids 2. Children under 5 years old (National TB guideline 2015, TB National strategic plan 2016-2019)
Sub-population
Populat ion size estimate
Source of estimate
PLHIV
708,000
NAP (2014)*
Contacts to bacteriologically positive pulmonary TB
2,795,000
Estimates based on NSP 2013
People > 55 years of age
31,310,000
BPS 2014
Urban poor
10,500,000
BPS 2014
Prisoners, including pre- 167,000 trial detainees
Ditjen Pas (2014)
Malnourished under five
4.645.2000
BPS (2014)
Pregnant women
5,298,315
Ditjen Bina Gizi & KIA (2013)
Diabetes
9,116,000
IDF (2014)
children
IPT for PLWHA Steps of IPT for PLWHA implementation in Indonesia IPT piloting in 4 major ARV hospitals May to November 2012
2013 : IPT expansion to 8 provinces (each 4 ARV hospitals)
2014 : IPT expansion to 15 provinces
2015 : IPT expansion to 11 provinces
2016 : Nation wide expansion
Early implementation of IPT in Indonesia
Algorithmic Approach to Diagnosis and Treatment LTBI for People Living with HIV AIDS • All PLWHA coming to ARV clinic will be screen for sign and symptoms of TB • Those with symptoms will do sputum examination using Xpert • If TB is confirmed patient will be treated for TB treatment • And if TB is not confirmed patient will receive INH 300 mg and B 6 25 mg for 6 month duration daily • In 2015 we have enrolled 610 PLWHA on IPT
Reporting & Recording form IPT for PLWHA • web based format to record IPT (IPTIS) is used for early implementation in 4 selected hospitals • Now IPT RR system is integrated in SIHA ( HIV Aids Information system)
Reporting & Recording form IPT for PLWHA REGISTER ART (2) 12
13
15
16
17
18
19
Nama Paduan ART Orisinal
Switch dengan ARV lini ke-2
Akhir follow-up dengan ART
Jumlah Viral Load
Pemberian PP INH Saat Mulai ART (Y/T)
Substitusi dgn ARV lini ke-1
Jumlah CD4 (% utk anak dan ibu hamil)
Tgl. subst. Pd saat mulai Rx
Pd 6 bulan
Pd 12 bulan
Pd saat mulai Rx
Pd 6 bulan
Pd 6 bulan
Pd 6 bulan
Pd 12 bulan
Pd saat mulai Rx
Pd 6 bulan
Pd saat mulai Rx
Pd 6 bulan
Pd 12 bulan
Pd 6 bulan
Pd 12 bulan
Pd saat mulai Rx
Pd 6 bulan
Pd 12 bulan
Pd 12 bulan
Pd saat mulai Rx
Pd saat mulai Rx
Pd 12 bulan
Pd 12 bulan
Pd saat mulai Rx
Pd 6 bulan
Pd 12 bulan
Pd 12 bulan
Pd saat mulai Rx
Pd saat mulai Rx
Pd saat mulai Rx
Pd 6 bulan
Pd 12 bulan
Pd 6 bulan
Pd saat mulai Rx
Pd 12 bulan
Pd 6 bulan
Alasan
Paduan baru Tgl switch Alasan Paduan baru
Tgl. Meninggal
Tgl stop
Tgl gagal FU (kunjungan terakhir)
Tgl Rujuk Keluar dgn ART
Report ART Lembar 1
Implementation of Latent TB Infection for Children under 5 years old • INH provision for children under 5 yo in Indonesia have been mentioned in National guideline since 2007 but the documentation form hasn’t been developed • In 2015, guidelines of contact investigation and IPT provision for children under 5 years old have been developed along with reporting recording format. The guidelines have been disseminated to 7 provinces in the last quarter of 2015 • NTP have procured INH 100 mg and ensured its availability
Algorithmic Approach to Diagnosis and Treatment LTBI for Children under 5 years old
Reporting and Recording form for IPT provision children <5yrs
Challenges IPT for PLWHA • Low enrollment rate for IPT among PLWHA (610/3809) • Dissemination process from central level to district • To increase commitment from clinician for IPT • To maintain patient adherence IPT for children under 5 years old : • Process to expand implementation nationwide • Difficulties in diagnosing TB in children • Maintaining patient adherence
Further opportunities for the implementation of the programmatic management of LTBI • IPT for TB in congregate setting From on going study of latent TB infection in Jakarta prison, approximately 52% inmates have latent TB infection
• Integrate IPT to PMTCT • LTBI treatment for DR TB contact • Shorter duration of treatment
